Enteric pathogens can be transmitted through multiple environmental pathways, yet little is known about the relative contribution of each pathway to diarrhea risk among children. We aimed to identify fecal transmission pathways in the household environment associated with prospectively measured child diarrhea in rural Bangladesh. We measured the presence and levels of Escherichia coli in tube wells, stored drinking water, pond water, child hand rinses, courtyard soil, flies, and food in 1843 households. Gastrointestinal symptoms among children ages 0–60 months were recorded concurrently at the time of environmental sample collection and again a median of 6 days later. Incident diarrhea (3 or more loose stools in a 24-h period) was positively associated with the concentration of E. coli on child hands measured on the first visit (incidence rate ratio [IRR] = 1.23, 95% CI 1.06, 1.43 for a log₁₀ increase), while other pathways were not associated. In cross-sectional analysis, there were no associations between concurrently measured environmental contamination and diarrhea. Our findings suggest higher levels of E. coli on child hands are strongly associated with subsequent diarrheal illness rates among children in rural Bangladesh.

The U.S. Food and Drug Administration (FDA) has defined standards for the microbial quality of agricultural surface water used for irrigation. According to the FDA produce safety rule (PSR), a microbial water quality profile requires analysis of a minimum of 20 samples for Escherichia coli over 2 to 4 years. The geometric mean (GM) level of E. coli should not exceed 126 CFU/100 mL, and the statistical threshold value (STV) should not exceed 410 CFU/100 mL. The water quality profile should be updated by analysis of a minimum of five samples per year. We used an extensive set of data on levels of E. coli and other fecal indicator organisms, the presence or absence of Salmonella, and physicochemical parameters in six agricultural irrigation ponds in West Central Florida to evaluate the empirical and theoretical basis of this PSR. We found highly variable log-transformed E. coli levels, with standard deviations exceeding those assumed in the PSR by up to threefold. Lognormal distributions provided an acceptable fit to the data in most cases but may underestimate extreme levels. Replacing censored data with the detection limit of the microbial tests underestimated the true variability, leading to biased estimates of GM and STV. Maximum likelihood estimation using truncated lognormal distributions is recommended. Twenty samples are not sufficient to characterize the bacteriological quality of irrigation ponds, and a rolling data set of five samples per year used to update GM and STV values results in highly uncertain results and delays in detecting a shift in water quality. In these ponds, E. coli was an adequate predictor of the presence of Salmonella in 150-mL samples, and turbidity was a second significant variable. The variability in levels of E. coli in agricultural water was higher than that anticipated when the PSR was finalized, and more detailed information based on mechanistic modeling is necessary to develop targeted risk management strategies.

In this study, the suitability of an anaerobic biofilter (AnBF) as an efficient and low-cost wastewater treatment for safer irrigation water production for Sub-Saharan Africa was investigated. To determine the influence of different ubiquitous available materials on the treatment efficiency of the AnBF, rice husks and their pyrolysed equivalent, rice husk biochar, were used as filtration media and compared with sand as a common reference material. Raw sewage from a municipal full-scale wastewater treatment plant pretreated with an anaerobic filter (AF) was used in this experiment. The filters were operated at 22 °C room temperature with a hydraulic loading rate of 0.05 m·h−1 for 400 days. The mean organic loading rate (OLR) of the AF was 194 ± 74 and 63 ± 16 gCOD·m−3·d−1 for the AnBF. Fecal indicator bacteria (FIB) (up to 3.9 log10-units), bacteriophages (up to 2.7 log10-units), chemical oxygen demand (COD) (up to 94%) and turbidity (up to 97%) could be significantly reduced. Additionally, the essential plant nutrients nitrogen and phosphorous were not significantly affected by the water treatment. Overall, the performance of the biochar filters was significantly better than or equal to the sand and rice husk filters. By using the treated wastewater for irrigating lettuce plants in a pot experiment, the contamination with FIB was >2.5 log-units lower (for most of the plants below the detection limit of 5.6 MPN per gram fresh weight) than for plants irrigated with raw wastewater. Respective soil samples were minimally contaminated and nearly in the same range as that of tap water.

Fecal-oral pathogens are transmitted through complex, environmentally mediated pathways. Sanitation interventions that isolate human feces from the environment may reduce transmission but have shown limited impact on environmental contamination. We conducted a study in rural Bangladesh to (1) quantify domestic fecal contamination in settings with high on-site sanitation coverage; (2) determine how domestic animals affect fecal contamination; and (3) assess how each environmental pathway affects others. We collected water, hand rinse, food, soil, and fly samples from 608 households. We analyzed samples with IDEXX Quantitray for the most probable number (MPN) of E. coli. We detected E. coli in source water (25%), stored water (77%), child hands (43%), food (58%), flies (50%), ponds (97%), and soil (95%). Soil had >120 000 mean MPN E. coli per gram. In compounds with vs without animals, E. coli was higher by 0.54 log₁₀ in soil, 0.40 log₁₀ in stored water and 0.61 log₁₀ in food (p < 0.05). E. coli in stored water and food increased with increasing E. coli in soil, ponds, source water and hands. We provide empirical evidence of fecal transmission in the domestic environment despite on-site sanitation. Animal feces contribute to fecal contamination, and fecal indicator bacteria do not strictly indicate human fecal contamination when animals are present.

Slightly acidic electrolyzed water (SAEW) with available chlorine concentrations (ACC) of 35 and 70 mg/L is used instead of regular production water for soaking pea (Pisum sativum L.) seeds and spraying the sprouts during seed sprouting. Sodium hypochlorite (NaOCl) with the same ACC and tap water are used as a control in this study. The population of total bacteria, coliform, yeast and mold are determined at day 2, day 5, day 8, and day 11, respectively during seed sprouting. The biological indicators, nutritive indicators, and nitrite content after the sprouts are harvested are measured as well. The results indicate that when treated with SAEW, the counts of total bacteria, coliform, yeast and mold are reduced by 0.99–1.58 log CFU/g, 0.57–1.02 log CFU/g, and 1.01–1.22 log CFU/g respectively, compared to tap water treatment. Fresh weight, length, and edible rate of the sprouts significantly improve when treated with SAEW (p < 0.05). No evident adverse effects are observed in the nutritive indicators after SAEW treatment. In fact, a slight improvement (soluble sugar, flavonoid) was evident. Moreover, after a storage period of 7 d, the nitrite content of the sprouts was significantly lower in the SAEW treated samples than in any of other treatments. Therefore, SAEW could be a promising application in the production of pea sprouts to ultimately improve food safety.

Sanitation improvements have had limited effectiveness in reducing the spread of fecal pathogens into the environment. We conducted environmental measurements within a randomized controlled trial in Bangladesh that implemented individual and combined water treatment, sanitation, handwashing (WSH) and nutrition interventions (WASH Benefits, NCT01590095). Following approximately 4 months of intervention, we enrolled households in the trial’s control, sanitation and combined WSH arms to assess whether sanitation improvements, alone and coupled with water treatment and handwashing, reduce fecal contamination in the domestic environment. We quantified fecal indicator bacteria in samples of drinking and ambient waters, child hands, food given to young children, courtyard soil and flies. In the WSH arm, Escherichia coli prevalence in stored drinking water was reduced by 62% (prevalence ratio = 0.38 (0.32, 0.44)) and E. coli concentration by 1-log (Δlog₁₀ = −0.88 (−1.01, −0.75)). The interventions did not reduce E. coli along other sampled pathways. Ambient contamination remained high among intervention households. Potential reasons include noncommunity-level sanitation coverage, child open defecation, animal fecal sources, or naturalized E. coli in the environment. Future studies should explore potential threshold effects of different levels of community sanitation coverage on environmental contamination.